- Joined
- Sep 13, 2012
- Messages
- 143
- Reaction score
- 12
Does anyone have experience working in a clozapine clinic? Anyone have thoughts on the patient population, the objective and subjective pearls of using this medication? Much appreciated.
What's been your experience with Abilify, either oral or Maintena, for psychosis control? I've been mostly taught that it is an inferior antipsychotic when compared to Risperdal or Zyprexa for example. Obviously studies show that it works, which is why it's approved, but does it REALLY work?
It is an inferior antipsychotic to olanzapine or risperidone per the Leucht et al. multiple treatment meta-analysis but that doesn't mean it doesn't work or doesn't have a place in the treatment of schizophrenia for those who haven't tolerated other neuroleptics. There is a clear inverse correlation between efficacy and tolerability for these drugs. The worse the side effects (and particularly the fatter and sleepier they make you) the better neuroleptic they are! However, it is a reasonable drug to use in an outpatient setting. The problem with using inpatient is that it has a long half-life because of its active metabolite dehydro-aripiprazole (about 94 hours) so it takes about 19 days to reach steady state. That means that all that crazy uptitrating that happens on the inpatient unit is worthless and makes the drug harder to use for acutely decompensated patients. But in the outpatient setting entirely reasonable to use as long as you're not silly enough to try increasing it every week and scratching your head about why not much is happening.
There was also a lot of hype generated because of its novel action as a D2/5-HT1a partial agonist so I think people had high hopes for it and so it has been devalued perhaps more unfairly than it should. At the same time, it has aggressively gone after FDA approval and been successful for multiple indications on the submission of fairly flimsy date (bipolar maintenance approval on only 6 months worth of data anyone?)
It also seems to reverse the metabolic effects of other antipsychotics like clozapine and olanzapine. So it is a favorite add-on for clozapine as much for maangement of metabolic syndrome as augmentation. Not that we should be encouraging dual neuroleptic usage...
the only thing I will say about clozapine is an oft-forgotten/overlooked side-effect is the development of OCD. Which is very interesting in an of itself.
No love for Haldol or Prolixin? Saves tons of money.My go to for long-acting injectables are Risperdal Consta/Invega Sustenna
I fear that the "clozapine clinic" concept is being put forward by a psychiatrist who is willing to completely let go of the concept that s/he is a physician in addition to being a psychiatrist. I have a hunch that you'll find such psychiatrists underprescribe Lithium when it's a rational choice and do less standard practice follow-up labs.Are Clozapine clinics common? I don't think I've heard of the concept, and I'm not sure I understand why patients put on this medication should go to a special clinic for it instead of seeing their usual psychiatrist.
Ditto this.No love for Haldol or Prolixin? Saves tons of money.
I fear that the "clozapine clinic" concept is being put forward by a psychiatrist who is willing to completely let go of the concept that s/he is a physician in addition to being a psychiatrist. I have a hunch that you'll find such psychiatrists underprescribe Lithium when it's a rational choice and do less standard practice follow-up labs.
I have no problem with a "treatment resistant psychosis" clinic. This is a much different than a Clozapine Clinic. The former recognizes a severity of illness, the latter prejudices to a particular modality, which is poor strategy.
No love for Haldol or Prolixin? Saves tons of money.